Ankle Dorsi Flexion

Ankle Dorsi Flexion

Ankle dorsiflexion is the movement of pulling the toes upward toward the shin, decreasing the angle between the foot and the lower leg. It is essential for walking, running, and maintaining balance.

Ankle Dorsi Flexion and Planter Flexion: What Are They?

Two essential ankle joint movements, ankle dorsiflexion, and plantarflexion, are necessary for various tasks, including walking, running, jumping, and maintaining balance. These motions require the foot to flex and extend at the ankle.

To get the toes closer to the shinbone, a movement known as dorsiflexion requires moving the top of the foot toward the shin. Primarily, the tibialis anterior muscle and other muscles at the front of the lower leg control this activity. Ankle dorsiflexion facilitates a fluid and effective gait pattern by allowing the foot to clear the ground during the walking swing phase.

Conversely, plantarflexion is the movement of the foot downward by pointing the toes away from the shinbone. The muscles in the back of the lower leg, such as the gastrocnemius and soleus muscles, are primarily responsible for this action. For tasks like pushing off the ground when jogging or walking and keeping your balance when standing on tiptoe, plantarflexion is important.

To maintain a healthy and effective ankle joint, both plantarflexion and dorsiflexion are required. Effective mobility and injury prevention depend on appropriate foot and ankle position, which is made possible by the proper range of motion in these motions. Restricted dorsiflexion or plantarflexion range of motion can result in abnormal gait, decreased athletic performance, and a higher risk of ankle injury.

Ankle dorsiflexion and plantarflexion can be affected by a variety of factors, such as joint mobility, prior injuries, muscle strength and flexibility, and specific medical disorders. To maximize ankle function and lower the risk of injury, it is critical to maintain a balanced range of motion and strength in both motions through consistent stretching and strengthening activities.

Ankle Dorsi Flexion: What Is It?

When the foot moves up toward the lower leg, or when the toes pull toward the lower leg, this action is known as ankle dorsiflexion. This action is the reverse of plantar flexion, which lowers the foot.

The ankle joint, where the talus (foot bone) and tibia (shin bone) articulate, is where dorsiflexion mostly takes place. The tibialis anterior and other muscles in the front of the lower leg are the main muscles responsible for ankle dorsiflexion. Walking, running, and ascending stairs are made possible by the contraction and elevation of these muscles in the foot and toes.

Regular walking and other physical activities require adequate ankle dorsiflexion. During the walking swing phase, this allows the foot to clear the ground, maintaining adequate clearance and avoiding toe drag. Lacking ankle dorsiflexion can cause problems with gait, make it harder to do tasks that need ankle mobility, and raise the risk of accidents such as ankle sprains.

Ankle dorsiflexion can be improved by several stretching, strengthening, and range-of-motion exercises. Sports medicine specialists or physical therapists include the medical practitioners who could suggest these workouts. For a complete examination and individualized guidance on ankle dorsiflexion exercises, it is important to consult with a trained healthcare provider.

Muscles of the Ankle Dorsi Flexors

The primary muscles at the front of the foot are in the role of dorsiflexing the ankle, which raises the foot and toes. The following are the primary muscles used in ankle dorsiflexion:

• Tibialis anterior: The main dorsiflexor of the ankle, this muscle is located on the front of the lower leg. It is in the role of pulling the leg up and running along the tibia (shinbone) to the inside of the leg.
• Extensor Hallucis Longus: This muscle is situated on the outside of the lower leg. It extends from the big toe to the fibula, a bone in the lower leg. It plays a role in both the big toe’s extension and the ankle’s dorsiflexion.
• Extensor Digitorum Longus: This muscle is situated on the outside of the calf, next to the extensor longus. With just the tip of the big toe, it extends from the fibula to the toes. It is in control of the extension and assists in ankle dorsiflexion.
• Peroneus Tertius: The peroneus tertius muscle is situated between the extensors on the outside of the lower leg. It travels to the fifth metatarsal (outside the foot) along the fibula. This facilitates foot rotation (moving the foot outward) and ankle dorsiflexion.

During ankle dorsiflexion, these muscles assist in raising the foot and toes. Particularly, additional muscles including the flexor hallucis longus and tibialis posterior also play a role in ankle dorsiflexion, but to a lesser degree. However, the main ankle dorsiflexion muscles are the same as listed above.

Ankle Dorsi Flexion Range of Motion

Although each person’s ankle dorsiflexion range of motion is different, it is generally agreed that an ankle dorsiflexion range of around 10–20 degrees beyond neutral is normal. Take it simply, the foot should be able to travel 10–20 degrees from the neutral position, which is flat on the ground, up to the calf.

In order to measure ankle dorsiflexion and evaluate joint angles, a goniometer can be utilized. The subject commonly lies on their back, knee extended, leg relaxed, during the measurement. To align the goniometer, one arm must be outside the lower leg and the other arm must be in line with the metatarsals, or foot bones. The region of ankle dorsiflexion is shown by the angle created at the hand-hand intersection.

It is essential to remember that different people may exhibit varying degrees of ankle dorsiflexion for a variety of reasons, including heredity, joint shape, prior injuries, and muscle stress. There are several causes of limited ankle dorsiflexion, such as soft tissue tension, joint stiffness, or muscle imbalances. A person’s functional activities and movement patterns may be impacted by limits in ankle dorsiflexion, which may raise their risk of injury or change their stride.

A doctor, such as an orthopedist or physiotherapist, should be consulted if you have discomfort or difficulties moving your ankle or if you have concerns regarding its dorsiflexion region. If required, they can evaluate your particular circumstances, advise suitable solutions, and guide you through exercises or therapies to enhance ankle dorsiflexion.

The ankle’s dorsiflexion range of motion can be measured by:

• Positioning: Ask that the subjects sit with their legs out in front of them on a sturdy platform.
• Stabilization: Make sure the heel stays on the ground or another sturdy surface.
• Alignment: Confirm that neither the foot nor the leg are rotated in or out.
• Zero point: Find the leg’s initial position when it is not dorsiflexed.
• Measurement: To find the dorsiflexion angle, use a goniometer, a rotating arm, and a device with graduations.
• Positioning the goniometer: Align the goniometer’s center of rotation with the ankle joint’s center of rotation.
• Placement of the Stationary Arm: Point the goniometer’s fixed arm toward the hip joint by aligning it with the leg.
• Placement of the moving arm: Point the goniometer’s moving arm toward the toes and line it up with the leg.
• Range of Motion: As you hold the goniometer in place, ask the subject to slowly bend their leg up (dorsiflexion). Throughout the movement, make sure the leg remains in position.
• Read the measurement. Check the goniometer’s degree reading once the subject has reached maximal dorsiflexion. The ankle’s dorsiflexion range of motion is represented by this measurement.
• Again: To guarantee clarity and regularity, take the measurement two or three times.
• Note the measurements: Measurements of the range of motion should be recorded for comparison or future use.

If you want the person’s comfort and cooperation, keep in mind that it is critical to be kind and keep in touch with them during the procedure.

Ankle Dorsi Flexion Special Test

To measure ankle dorsiflexion and identify certain restrictions or dysfunctions, medical experts employ a variety of specialized tests. The following are some typical special ankle dorsiflexion tests:

Silfverskiold Test:

This test differentiates between soleus and gastrocnemius muscle tension. The knee of the person lying on the ground (image below) is bent at a 90-degree angle. After that, the examiner passively flexes the ankle while extending and dorsiflexing the knee. A strain in the gastrocnemius muscle is indicated if there is a noticeable increase in ankle dorsiflexion when the knee is extended as opposed to flexed. If the restriction is present in any knee position, it is a sign of plantar muscular tension.

Weight-Bearing Lunge Test

The test involves the subject standing with the front foot slightly off the wall in a split flea stance. The person tries to contact the wall with the front knee while maintaining the heel on the floor by placing it over the other toe. There is restricted ankle dorsiflexion if the knee cannot reach the wall without raising the heel.

Heel-to-Wall Test:

With both feet pointed directly ahead, the person stands with their toes about 5 inches (12 cm) from the wall. Then, while maintaining their heels on the floor, they bend their knees and try to contact the wall with them. Ankle dorsiflexion is limited if the heels are unable to remain in touch with the floor.

Ankle Dorsiflexion Range of Motion Test: As mentioned before, this test measures the ankle dorsiflexion range of motion using a goniometer. To measure the angle between the metatarsals, the goniometer points at the fibula while the subject is lying supine with the knee extended. The degree of ankle dorsiflexion is indicated by the angle.

Healthcare practitioners may evaluate ankle dorsiflexion with the use of these specific tests, which also provide useful data for diagnosis, treatment planning, and progress tracking. They are usually performed by qualified experts including orthopedists, sports medicine specialists, and physiotherapists. For a comprehensive assessment and appropriate testing, it is important to speak with a skilled doctor if ankle dorsiflexion is causing you any worry.

Manual Muscle Testing For Ankle Dorsiflexion

Ankle manual muscle testing, or MMT, is a physical examination method used to evaluate the function and strength of the muscles around the ankle joint. Healthcare providers, such as doctors or physical therapists, frequently do it to assess muscle weakness, record rehabilitation progress, or identify specific ankle issues.

Muscle testing

• Tibialis Anterior
• Extensor Digitorum Longus
• Peroneus Tertius
• Extensor Hallucis Longus

Position of the patient

The patient should sit for a short period with their ankle hanging over the bed.

The patient should be side-lying with minimum gravity to evaluate grades 0–2.

Position of the Therapist

In front of the patient, the therapist must take a seat on a chair or stool.

Perform the anterior tibialis palpation.

Resistance force over the dorsal foot is applied with the opposite hand.

What is the test procedure?

• Stabilize the joint: Place one hand on each side of the ankle to stabilize the joint being evaluated. This will avoid any uncomfortable movement during the test.
• Apply resistance: As the patient presses down, provide resistance against the ball of the foot. Use sufficient pressure to create resistance without overloading the patient’s efforts.
• Check for range of motion: As the patient presses down, check for a complete range of motion. Make a note of any incomplete ranges of motion.

Muscle strength should be graded based on the patient’s effort and the amount of resistance used.

• Grade 0: There is no visible contraction
• Grade 1: There is no movement, just a flash or sign of contraction.
• Grade 2: Perform the motion without using gravity, such as horizontal
• Grade 3: Move against gravity without resistance.
• Grade 4: Use mild to moderate resistance force when moving against gravity.
• Grade 5: do the activity that goes against your strongest muscles.

• Repeat on both sides: To compare the muscle strength and identify any variations, repeat the test on both sides.
• Record: Record the muscular strength score and any test-related observations in the patient’s medical file.
• Interpretation: A trained healthcare expert should interpret the data, taking into consideration additional variables including age, gender, medical history, and other clinical findings.

Ankle Dorsi Flexion Exercise

Ankle dorsiflexion can be enhanced using a variety of exercises. Here are a few examples:

Towel stretching:

While sitting on the ground, extend your legs in front of you. You can wrap a towel or a resistance band around your foot’s ball. Without bending your knee, gently pull the band or cloth in your direction. It should start to extend the back of your leg. Repeat many times for each leg after holding the stretch for 30 seconds.

Calf Stretch on the Wall:

With your hands shoulder-height against the wall, face it. Maintaining your foot on the ground, take a step back. Feeling the stretch in the back leg’s calf, gradually bend forward while maintaining the front knee bent. Repeat many times for each leg after holding the stretch for 30 seconds.

Ankle Dorsiflexion Stretch:

Place your feet hanging over the edge of a table or chair. Bend your ankles and slowly bring your toes toward your shins after pointing them as far down as you can. For a few seconds, hold the stretch at the top, and then let go. Do this movement ten to fifteen times.

Heel-raising

If necessary, utilize a sturdy platform for balance while keeping your feet hip-width apart. Raise your heels as high as you can while slowly rising to your toes. After that, gradually bring your heels down to the ground. Repeat ten to fifteen times.

Ankle Alphabet

One leg should be extended in front of you as you sit in a chair. With your foot in the air, “write” the alphabet while acting like your big toe is a pencil. Use your whole range of motion while moving slowly and purposefully. On the opposite leg, use the same method.

By strengthening and stretching the muscles used to dorsiflex the ankle, these exercises assist improve flexibility and range of motion. It is essential to begin the exercises softly and increase their time and intensity progressively based on ability. For advice and individualized exercise suggestions, it is advised that you speak with a health expert, such as a physiotherapist, if you have any conditions or issues.

FAQs

References:

• Patel, D. (2023y, July 13). Ankle dorsi flexion and planter flexion. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/ankle-dorsi-flexion-and-planter-flexion/
• Patel, D. (2023i, May 29). Manual Muscle Testing of Ankle(MMT of Ankle Muscle) – Samarpan. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/manual-muscle-testing-of-ankle/#Ankle_Dorsiflexion